CDC Issues New Pneumococcal Vaccine Recommendations for Adults

Updated pneumococcal vaccine recommendations for adults from the CDC call for the use of the two recently approved vaccines in a more streamlined approach to avoid the complexities of age and patient conditions that hindered previous recommendations.

The recommendations, voted on by the CDC's Advisory Committee of Immunization Practices (ACIP) in October and made final last week with publication in the agency's Morbidity and Mortality Weekly Report (MMWR), call for use of the 15-valent pneumococcal conjugate vaccine (PCV15; Vaxneuvance, Merck Sharp & Dohme) or 20-valent PCV (PREVNAR20; Wyeth Pharmaceuticals).

The recommendations apply to PCV-naive adults in the US who are either aged 65 years or older, or who are aged 19-64 years and have underlying conditions such as diabetes, chronic heart or liver disease, or HIV, and have not previously received a PCV or whose previous vaccination history is unknown.

If the PCV15 vaccine is used, a subsequent dose of the 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax23, Merck Sharp & Dohme) should be provided, typically at least 1 year later, under the recommendations.

As reported by Medscape Medical News, PCV15 and PREVNAR20 received approval from the US Food and Drug Administration (FDA) last July.

Those approvals provided an impetus for the revised recommendations, "offer[ing] an opportunity to review the existing recommendations and available data," Miwako Kobayashi, MD, first author of the MMWR report and a medical epidemiologist with the National Center for Immunization and Respiratory Diseases, CDC, in Atlanta, Georgia, told Medscape Medical News.

"As part of that process, ACIP strived to simplify the recommendations," she said.

The previous recommendations called for the PCV13 vaccine and the PPSV23 and had varying conditions (depending on certain age and risk groups) that added complexity to the process. Under the new approach, the same recommendation applies regardless of specific medical conditions or other risk factors.

"With the simplified recommendation for adults 19 through 64, we expect coverage may increase among this population," Kobayashi said.

Compared with the PCV13 vaccine, PREVNAR20 protects against seven additional serotypes involved in cases of invasive pneumococcal disease (IPD) and pneumonia, which are responsible for up to 40% of all cases of pneumococcal disease and related deaths in the US.

While the PREVNAR20 includes five more pneumococcal serotypes than PCV15, the

CDC does not recommend one over the other, Kobayashi noted.

More than 90% of cases of adult IPD involve older adults and adults with chronic medical conditions or immunocompromising conditions, cerebrospinal fluid leaks, or cochlear implants, the MMWR report notes.

Commenting on the recommendations, Amit A. Shah, MD, a geriatrician with the Mayo Clinic in Phoenix, Arizona, underscored the need for clinicians to be proactive in recommending the vaccines to those patients.

"Despite only needing one vaccine dose after turning 65 to be considered vaccinated, only about 70% of people in this group have received any pneumococcal vaccination," he told Medscape Medical News. "This percentage has not increased much over the past several years."

The new approach should help change that, he said.

"These new recommendations are a significant simplification from the prior confusing and challenging-to-implement recommendations from 2019," Shah explained.

Among the 2019 recommendations was a stipulation for "shared decision-making" with PCV13, and a conversation that often only complicated matters, he noted.

"Patients and providers alike had confusion about this since it was not a clear-cut 'yes, give it' or 'no, do not give it any longer' recommendation."

Dr Amit Shah

"Now that this new recommendation will require no extra time for a discussion in the clinic, and just a simple 'it's time for your pneumonia shot' offer, this may become more feasible," Shah added. "In addition, removal of the shared decision-making stipulation allows for this immunization to be easily protocolized in the clinic, similar to automatic offers to the flu vaccine for patients each year."

According to the CDC, pneumococcal pneumonia causes an estimated 150,000 hospitalizations each year in the United States, while pneumococcal meningitis and bacteremia killed approximately 3250 people in the United States in 2019.

"Clinicians are patients' most trusted resource when it comes to vaccine recommendations," Kobayashi said. "We encourage all clinicians to recommend pneumococcal vaccines when indicated."

Kobayashi and Shah have disclosed no relevant financial relationships.

MMWR Morb Mortal Wkly Rep. Published January 28, 2022. Full text

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